STUDENT EMPLOYMENT APPLICATION

Name : ________________________________________ Social Security No:_______________________
_______________________________________________________(Optional)

Permanent Address:___________________________Local Address:

__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________

Phone: ____________________________________Phone: __________________________
__________________________________________Userid: _________________________

I. Are you currently enrolled at Carnegie Mellon ( ) Yes__( ) No

__Current year in school:___( ) 1st Year___( ) Sophomore___( ) Junior___( ) Senior___( ) Grad Student

__Department: _______________________ Major: ________________________ GPA: __________

II. Are you currently employed by any other department(s) at Carnegie Mellon? ( ) Yes____( ) No

If yes:_Department:________________Position Title:___________Supervisor's name:

1. _______________________ ________________ ____ ________________
2. _______________________ ________________ ____ ________________

III. Have you worked at Carnegie Mellon before? ( ) Yes____( ) No

If yes:_Department:________________Position Title:___________Supervisor's name:

1. ___________________________________________ ________________
2. ___________________________________________ ________________

IV. Previous Employment outside of Carnegie Mellon : (Use additional space on back if necessary)

Name of Company:________Position Title:_________Employment Dates:
1. _________________________________________________________
2. _________________________________________________________
3. _________________________________________________________

V. Position you are currently applying for: ___________________________________________

Related Experience: ____________________________________________________________

____________________________________________________________________________

Computer or word-processing skills: _______________________________________________

Hours/Times Available to work per week: ___________________________________________

 

VI. Have you been awarded a Federal Work-study Award? ( ) Yes ( ) No

If yes, amount of Work-study awarded for the entire Academic year:__ $_________________

Signature: _______________________________________________ Date: __________